I'm sure you have patients like this in your practice.
My hygienist came to me last week totally flustered. She saw a patient who was not taking care of her mouth, which is admittedly nothing new. But this was not a new patient, as she had been coming to our office for a while. Yet, she was not taking the steps to help herself -- she was not self-motivating.
This patient has been coming to our office regularly for more than two years for her three-month hygiene appointments. My hygienist would clean her teeth and monitor her gum health. She would show the patient what was going on in her mouth with a mirror and review and demonstrate the necessary cleaning techniques that might improve her mouth's health. I also had discussed the importance of gut health and how it could affect her mouth and overall health.
This patient has had an unhealthy mouth for some time. Although my hygienist always re-emphasizes what the patient needs to do for her teeth and gums, this patient still presents at each appointment with lots of gum disease and unhealthy dental plaque.
Understandably, my hygienist was frustrated, and she asked me, "What should I do with [this patient]?" It appears that this patient, like many patients, has no idea what compliance means.
Just the facts
Sometimes (probably most times), just facts are not enough to make people react in the way we'd like them to react. No person can motivate someone else. No person can make another become compliant. Telling a person to get motivated is not going to work.
Motivation must develop from within that person and often emanates from an emotional response. A person must believe in the "why" to make a change. A person must self-motivate to move forward.
The science of helping people to self-motivate is complex. Each situation must be dealt with individually. However, there are some basic guidelines that might suggest a dialogue with the patient to help her.
I suggested five questions for my hygienist to ask this patient. The questions are designed to help the patient take personal responsibility for her actions and the eventual outcomes from these actions. Of course, the response to each question would determine the way the next question would be asked.
- Are you interested in making your mouth healthier?
- What are your three main reasons to make this change?
- What do you think could happen if you don't make this change?
- If you want to make a change, what do you think you need to do to be successful?
- What steps do you want to take for us to help you make that change?
These questions emphasize "you." They might help the patient understand her "why." They also could strike an emotional core within the patient to spark her into action. She may respond in a proactive way to make the change and to ask us how we can help her to make this happen.
My hygienist already scheduled this patent for a follow-up appointment in a month. At that appointment, I suggested that my hygienist ask these questions and listen to her answers.
Our goal is for this patient to become emotionally involved with -- and responsible for -- her outcome. If she begins to own her responses as well as the course of her health, then maybe she will ask us for the specific steps our office can take to help her make a difference for herself going forward.
Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.
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